Claustrophobia and disruptive patient motion-longtime common impediments to MRI examination-can be prevented or ameliorated with a non-pharmacologic behavioral intervention administered by trained staff. The potential benefits of such an intervention are highly significant as current practice alternatives are to cancel the study or administer sedation. Inability to complete their MRI scans adversely affects an estimated 700,000 patients every year in the US who are either deprived of a diagnosis, subject to diagnostic delays and interpretation errors due to motion, or are exposed to risks of pharmacologic sedation, including death. The imaging facilities, in turn, typically cannot fill the suddenly vacated scan slots and risk considerable lost revenue and efficiency. The resulting negative patient experiences further lower patient satisfaction ratings. The long-term goal is to provide a validated, clinically feasible means for non-pharmacologic amelioration of claustrophobia and disruptive patient motion in MR imaging, by training facility staff to assist patients through advanced rapport skills and comforting language. Phase I accomplishments include designs of a prototype of Comfort Talk(R) Training and a facility-site-specific customizable online Training Support Platform to support MRI staffs in personalizing their skill development. The results: significantly reduced cancellations, improved efficiency and increased patient satisfaction based on national benchmarks. The goal of Phase II is to enable scaling and definitive testing of the hypothesized benefits for broad-based commercialization. Specific Aim 1 pursues development of a scalable, prototype for trainer training and certification using the flipped classroom principle: beginning with preparatory web-based course-work to maximize time for mutual feedback and pedagogical skill practice during live training. Practice and certification will include traditional tests and role-play, which will be progressively moved online into virtual environments within which a Candidate Trainer's avatar interacting with virtual Patient avatars is expected to choose appropriate Comfort Talk(R) strategies. In Aim 2, intra-institutional program adoption will be pursued through developing internal Trainer-Champions; supportive online courses for core staff who cannot participate in live training and for personnel who do not work in high anxiety and pain prone areas; and a customizable Comfort Talk(R) patient app, co-branded with the site to enable vertical integration to the patient level. The need for site-specific individualization with regard to use of vocabulary and behavior patterns of staff will be integrated by capture and analysis of site entries to enable scaling of customized culture-conscious content for specific patient populations and situations and further integration in subsequent training materials. Aim 3 targets unequivocal assessment of the effect of Comfort Talk(R) training, including the newly trained trainers and local champions. In a prospective randomized design at 12 MRI satellites of the Ohio State and Duke University Medical Center effects on patient satisfaction, economic outcomes, and return-on-investment will be assessed.